The breastfeeding and early motherhood experiences of older first-time mothers: A constructivist grounded theory study.

OBJECTIVE: The objective of this paper is to present the results of a qualitative study that explored the factors surrounding decision-making related to breastfeeding and the experiences of early motherhood for 23 first-time mothers over the age of 35 in Canada. Previous studies on breastfeeding have not examined older first-time mothers as a group that is unique due to their experience of coming to motherhood in the context of the growing phenomenon of delayed childbearing in the 21st century. Many older women come to motherhood with both well- established life and professional experiences, and as such their needs may differ from their younger or multiparous counterparts. The research question was: "What factors affect how first-time mothers >35 years of age make decisions about breastfeeding, and how do these factors affect the decisions they make related to breastfeeding and their transition to motherhood in the first six months postpartum?" DESIGN: Constructivist grounded theory FINDINGS: The theory of From Ideology to Independence: Older First-time Mothers, Breastfeeding, and Becoming a Mother provides a lens to view the underlying processes influencing the decisions the mothers made related to breastfeeding and early motherhood. The mothers worked through the processes of learning breastfeeding, redefining self, and defining motherhood. The mothers' belief that breastfeeding defines motherhood, coupled with lack of knowledge and control, had a negative effect on both early breastfeeding and their transition to motherhood. As the idea of breastfeeding equating successful mothering waned the mothers became active agents in decision-making related to infant feeding and mothering.

Client Experience with the Ontario Birth Center Demonstration Project.

INTRODUCTION: In 2014, 2 new freestanding midwifery-led birth centers opened in Ontario, Canada. As one part of a larger mixed-methods evaluation of the first year of operations of the centers, our primary objective was to compare the experiences of women receiving midwifery care who intended to give birth at the new birth centers with those intending to give birth at home or in hospital. METHODS: We conducted a cross-sectional survey of women cared for by midwives with admitting privileges at one of the 2 birth centers. Consenting women received the survey 3 to 6 weeks after their due date. We stratified the analysis by intended place of birth at the beginning of labor, regardless of where the actual birth occurred. One composite indicator was created (Composite Satisfaction Score, out of 20), and statistical significance (P < .05) was assessed using one-way analysis of variance. Responses to the open-ended questions were reviewed and grouped into broader categories. RESULTS: In total, 382 women completed the survey (response rate 54.6%). Half intended to give birth at a birth center (n = 191). There was a significant difference on the Composite Satisfaction Scores between the birth center (19.4), home (19.5), and hospital (18.9) groups (P < .001). Among women who intended to give birth in a birth center, scores were higher in the women admitted to the birth center compared with those who were not (P = .037). Overall, women giving birth at a birth center were satisfied with the learners present at their birth, the accessibility of the centers, and the physical amenities, and they had suggestions for minor improvements. DISCUSSION: We found positive experiences and high satisfaction among women receiving midwifery care, regardless of intended place of birth. Women admitted to the birth centers had positive experiences with these new centers; however, future research should be planned to reassess and further understand women's experiences.

Nurses' Moral Experiences of Ethically Meaningful End-of-Life Care: Distress, Resilience, Responsibility, and Care.

BACKGROUND: Moral distress, the phenomenon in which an agent is constrained in acting on their ethical choice, is a reoccurring theme in the literature on nurses' experiences of end-of-life care (EOLC). Understanding moral engagement solely through a lens of moral distress can be limiting-as such, we sought to explore the diverse experiences nurses consider ethically meaningful in their palliative and EOLC practice. PURPOSE AND METHODS: This article presents an exploration and analysis of stories told to us, within an interpretive description study, by five nurses practicing in EOLC in diverse settings across Canada. Although these stories were told to us in a research context, the purpose of this theory article is to explore what these stories demonstrate about the moral engagement of nurses caring for dying patients. FINDINGS: Our analysis suggests that while moral distress is a feature of nursing stories, so too are many other dimensions of moral experience, including resilience, responsibility, and care. IMPLICATIONS FOR PRACTICE: Expanding how we understand nurses' moral engagement in the care of dying patients has implications for how we account for the many responsibilities that nurses shoulder in striving to provide "good" care to people at the end of life.

Connecting With Adolescent Mothers: Perspectives of Hospital-Based Perinatal Nurses.

Adolescent mothers are more likely to be dissatisfied with their perinatal nursing care than adult mothers. The purpose of this interpretive descriptive study was to explore adolescent-friendly care from the perspective of hospital-based perinatal nurses. Twenty-seven interviews were conducted with nurses with expertise caring for adolescent mothers. Open-ended questions were used to determine how they adapted their nursing practice when caring for adolescents, how they learned to provide adolescent-friendly care, and the facilitators and barriers to providing adolescent-friendly care. Nurses described two main goals: (a) delivering a positive experience and (b) ensuring mother and infant safety. They accomplished these goals by being nonjudgmental, forming a connection, and individualizing nursing care. The nurses described being mother-friendly, regardless of maternal age, and employing strategies to develop a nurse-adolescent mother therapeutic relationship. This research contributes to our understanding of how hospital-based perinatal nurses engage and support adolescent mothers.

A mixed-methods evaluation of the MOREOB program in Ontario hospitals: participant knowledge, organizational culture, and experiences.

BACKGROUND: MOREOB (Managing Obstetrical Risk Efficiently) is a patient safety program for health care providers and administrators in hospital obstetric units. MOREOB has been implemented widely in Canada and gradually spread to the United States. The main goal of MOREOB is to build a patient safety culture and improve clinical outcomes. In 2013, 26 Ontario hospitals voluntarily accepted provincial funding to participate in MOREOB. The purpose of our study was to assess the effect of MOREOB on participant knowledge, organizational culture, and experiences implementing and participating in the program at these 26 Ontario hospitals. METHODS: A convergent parallel mixed-methods study in Ontario, Canada, with MOREOB participants from 26 hospitals. The quantitative component used a descriptive pre-post repeated measures design to assess participant knowledge and perception of culture, administered pre-MOREOB and after each of the three MOREOB modules. Changes in mean scores were assessed using mixed-effects regression. The qualitative component used a qualitative descriptive design with individual semi-structured interviews. We used content analysis to code, categorize, and thematically describe data. A convergent parallel design was used to triangulate findings from data sources. RESULTS: 308 participants completed the knowledge test, and 329 completed the culture assessment at all four time points. Between baseline and post-Module 3, statistically significant increases on both scores were observed, with an increase of 7.9% (95% CI: 7.1 to 8.8) on the knowledge test and an increase of 0.45 (on a scale of 1-5, 95% CI: 0.38 to 0.52) on the culture assessment. Interview participants (n = 15) described improvements in knowledge, interprofessional communication, ability to provide safe care, and confidence in skills. Facilitators and barriers to program implementation and sustainability were identified. CONCLUSIONS: Participants were satisfied with their participation in the MOREOB program and perceived that it increased health care provider knowledge and confidence, improved safety for patients, and improved communication between team members. Additionally, mean scores on knowledge tests for obstetric content and culture assessment improved. The MOREOB program can help organizations and individuals improve care by concentrating on the human and organizational aspects of patient safety. Further work to improve program implementation and sustainability is required.

Effect of implementation of the MOREOB program on adverse maternal and neonatal birth outcomes in Ontario, Canada: a retrospective cohort study.

BACKGROUND: In 2002, the MOREOB (Managing Obstetrical Risk Efficiently) obstetrical patient safety program was phased-in across hospitals in Ontario, Canada. The purpose of our study was to evaluate the effect of the MOREOB program on rates of adverse maternal and neonatal outcomes. METHODS: A retrospective cohort study, using province-wide administrative hospitalization data. We included maternal and neonatal records between fiscal years 2002-2003 and 2013-2014, for deliveries taking place at the 67 Ontario hospitals where the MOREOB program was implemented between 2002 and 2012. After accounting for institutional mergers and excluding very small hospitals, 55 hospitals (1,447,073 deliveries) were included. Multivariable logistic and linear mixed effects regression analysis were used, accounting for secular trends, within hospital correlation and over time correlation, and adjusting for a maternal comorbidity index, hospital annual birth volume, and level of care. The main outcome measure was a composite individual-level indicator of incidence of any adverse events, and a hospital-level score, called the Weighted Adverse Outcome Score (WAOS) capturing both maternal and neonatal adverse outcomes. RESULTS: Across the 12 years of follow up, there were 98,789 adverse maternal and neonatal outcomes, a rate of 6.83 per 100 deliveries (6.66 per 100 occurring before, 6.91 per 100 during, and 6.84 per 100 after program implementation). The multivariable analysis found no statistically significant decrease in adverse events associated with program implementation (OR for adverse events after versus before =1.11 (95% CI: 1.06 to 1.17, change in mean WAOS score after minus before =0.15 (- 0.36 to 0.67)). CONCLUSIONS: We did not find a reduction in the incidence of maternal and neonatal adverse outcomes associated with the MOREOB program, and small yet statistically significant increases in some adverse events were observed.

Use of a maternal newborn audit and feedback system in Ontario: a collective case study.

BACKGROUND: As part of a larger study examining the effectiveness of the Maternal Newborn Dashboard, an electronic audit and feedback system to improve maternal-newborn care practices and outcomes, the purpose of this study was to increase our understanding of factors explaining variability in performance after implementation of the Dashboard in Ontario, Canada. METHODS: A collective case study. A maximum variation sampling approach was used to invite hospitals reflecting different criteria to participate in a 1-day to 2-day site visit by the research team. The visits included: (1) semistructured interviews and focus groups with healthcare providers, leaders and personnel involved in clinical change processes; (2) observations and document review. Interviews and focus groups were audio-recorded and transcribed verbatim. Qualitative content analysis was used to code and categorise the data. RESULTS: Between June and November 2016, we visited 14 maternal-newborn hospitals. Hospitals were grouped into four quadrants based on their key indicator performance and level of engagement with the Dashboard. Findings revealed four overarching themes that contribute to the varying success of sites in achieving practice change on the Dashboard key performance indicators, namely, interdisciplinary collaboration and accountability, application of formal change strategies, team trust and use of evidence and data, as well as alignment with organisational priorities and support. CONCLUSION: The diversity of facilitators and barriers across the 14 hospitals highlights the need to go beyond a 'one size fits all' approach when implementing audit and feedback systems. Future work to identify tools to assess barriers to practice change and to evaluate the effects of cointerventions to optimise audit and feedback systems for clinical practice change is needed.

[Barriers to and facilitators for using a risk assessment tool to prevent violent behaviour in patients with mental health conditions: Perspectives of health care providers]. / Les obstacles et les facilitateurs à l'utilisation de l'évaluation du risque de violence auprès des personnes ayant des troubles mentaux : perceptions du personnel soignant.

Regular assessment of risk of violence is shown to be effective in reducing violence in mental health services. PURPOSE: To evaluate health care providers' use of a violence risk assessment tool on a mental health unit and the facilitators for and barriers to its use. METHODS: A descriptive study using the Dillman approach and informed by the Knowledge to Action framework was conducted. RESULTS: Twenty-six health care providers responded to the survey; 62% reported using the violence risk assessment tool available on their unit, but not on a daily basis. Common barriers were lack of knowledge of the tool, lack of resources and time, and negative attitudes toward patients. 42% of participants indicated the need for further training on violence risk assessment. CONCLUSION: Despite high exposure to violence, health professionals were not conducting daily risk assessments. The barriers and facilitators identified provide direction for interventions that are necessary if the daily use of violence risk assessment tools is to be increased.

The Integration of Ontario Birth Centers into Existing Maternal-Newborn Services: Health Care Provider Experiences.

INTRODUCTION: In 2014, 2 freestanding, midwifery-led birth centers opened in Ontario, Canada. The purpose of this study was to qualitatively investigate the integration of the birth centers into the local, preexisting intrapartum systems from the perspective of health care providers and managerial staff. METHODS: Focus groups or interviews were conducted with health care providers (paramedics, midwives, nurses, physicians) and managerial staff who had experienced urgent and/or nonurgent maternal or newborn transports from a birth center to one of 4 hospitals in Ottawa or Toronto. A descriptive qualitative approach to data analysis was undertaken. RESULTS: Twenty-four health care providers and managerial staff participated in a focus group or interview. Participants described positive experiences transporting women and/or newborns from the birth centers to hospitals; these positive experiences were attributed to the collaborative planning, training, and communication that occurred prior to opening the birth centers. The degree of integration was dependent on hospital-specific characteristics such as history, culture, and the presence or absence of midwifery privileging. Participants described the need for only minor improvements to administrative processes as well as the challenge of keeping large numbers of staff updated with respect to urgent transport policies. Planning and opening of the birth centers was seen as a driving force in further integrating midwifery care and improving interprofessional practice. DISCUSSION: The collaborative approach for the planning and implementation of the birth centers was a key factor in the successful integration into the existing maternal-newborn system and contributed to improving integrated professional practice among midwives, paramedics, nurses, and physicians. This approach may be used as a template for the integration of other new independent health care facilities and programs into the existing health care system.

Effect of a population-level performance dashboard intervention on maternal-newborn outcomes: an interrupted time series study.

OBJECTIVES: To assess the effect of the Maternal Newborn Dashboard on six key clinical performance indicators in the province of Ontario, Canada. DESIGN: Interrupted time series using population-based data from the provincial birth registry covering a 3-year period before implementation of the Dashboard and 2.5 years after implementation (November 2009 through March 2015). SETTING: All hospitals in the province of Ontario providing maternal-newborn care (n=94). INTERVENTION: A hospital-based online audit and feedback programme. MAIN OUTCOME MEASURES: Rates of the six performance indicators included in the Dashboard. RESULTS: 2.5 years after implementation, the audit and feedback programme was associated with statistically significant absolute decreases in the rates of episiotomy (decrease of 1.5 per 100 women, 95% CI 0.64 to 2.39), induction for postdates in women who were less than 41 weeks at delivery (decrease of 11.7 per 100 women, 95% CI 7.4 to 16.0), repeat caesarean delivery in low-risk women performed before 39 weeks (decrease of 10.4 per 100 women, 95% CI 9.3 to 11.5) and an absolute increase in the rate of appropriately timed group B streptococcus screening (increase of 2.8 per 100, 95% CI 2.2 to 3.5). The audit and feedback programme did not significantly affect the rates of unsatisfactory newborn screening blood samples or formula supplementation at discharge. No statistically significant effects were observed for the two internal control outcomes or the four external control indicators-in fact, two external control indicators (episiotomy and postdates induction) worsened relative to before implementation. CONCLUSION: An electronic audit and feedback programme implemented in maternal-newborn hospitals was associated with clinically relevant practice improvements at the provincial level in the majority of targeted indicators.

Validation of the Edinburgh Postnatal Depression Scale for Use With Young Childbearing Women.

BACKGROUND AND PURPOSE: The Edinburgh Postnatal Depression Scale (EPDS) was created specifically to screen for perinatal depression. The purpose of this study was to assess the psychometric properties of the EPDS for use in a population of pregnant and postpartum 14- to 24-year-olds in Canada. METHODS: The Standards for Educational and Psychological Testing was used as the psychometric framework to assess the validity, reliability, and acceptability of responses obtained using the EPDS with pregnant and postpartum adolescents and young adults. RESULTS: There were 102 young women who were surveyed. Principal component analysis supported the EPDS as a 2-dimensional instrument. Test scores also showed the EPDS to be reliable and acceptable. CONCLUSIONS: The EPDS was found to be a psychometrically sound tool for use in this population of young childbearing women.

Factors Influencing the Breastfeeding Practices of Young Mothers Living in a Maternity Shelter: A Qualitative Study.

BACKGROUND: Young mothers have the lowest breastfeeding rates in Canada. Young mothers and their infants who access maternity shelters are especially at risk for poor outcomes, some of which breastfeeding may help to mitigate, yet little is known of the breastfeeding practices of this population. Research aim: The purpose of this study was to answer the research question, "What factors influence the breastfeeding practices of young mothers who live or have lived in a maternity shelter?" METHODS: The study was conducted using interpretive description methodology and inductive content analysis. Data were collected by means of one-on-one interviews, with the participants recruited from a maternity shelter in Ontario, Canada. RESULTS: Nine young mothers ages 17 to 24 years, who had initiated breastfeeding and resided at a maternity shelter, were interviewed. The five themes that emerged from the data were as follows: (a) choice, (b) special, (c) importance of early postpartum support, (d) being part of the "in crowd," and (e) importance of ongoing supports. The participants in this study took ownership of their choice to breastfeed. Hospital postpartum nurses and lactation consultants had a critical role in the establishment of early breastfeeding, and ongoing, accessible, and nonjudgmental peer, family, and community support were important to breastfeeding duration. CONCLUSION: A combination of emotional and practical supports from multiple trusted sources, including professional and peer supports on an ongoing basis, enabled young mothers to reach their breastfeeding goals.

A mixed methods evaluation of the maternal-newborn dashboard in Ontario: dashboard attributes, contextual factors, and facilitators and barriers to use: a study protocol.

BACKGROUND: There are wide variations in maternal-newborn care practices and outcomes across Ontario. To help institutions and care providers learn about their own performance, the Better Outcomes Registry & Network (BORN) Ontario has implemented an audit and feedback system, the Maternal-Newborn Dashboard (MND), for all hospitals providing maternal-newborn care. The dashboard provides (1) near real-time feedback, with site-specific and peer comparison data about six key performance indicators; (2) a visual display of evidence-practice gaps related to the indicators; and (3) benchmarks to provide direction for practice change. This study aims to evaluate the effects of the dashboard, dashboard attributes, contextual factors, and facilitation/support needs that influence the use of this audit and feedback system to improve performance. The objectives of this study are to (1) evaluate the effect of implementing the dashboard across Ontario; (2) explore factors that potentially explain differences in the use of the MND among hospitals; (3) measure factors potentially associated with differential effectiveness of the MND; and (4) identify factors that predict differences in hospital performance. METHODS/DESIGN: A mixed methods design includes (1) an interrupted time series analysis to evaluate the effect of the intervention on six indicators, (2) key informant interviews with a purposeful sample of directors/managers from up to 20 maternal-newborn care hospitals to explore factors that influence the use of the dashboard, (3) a provincial survey of obstetrical directors/managers from all maternal-newborn hospitals in the province to measure factors that influence the use of the dashboard, and (4) a multivariable generalized linear mixed effects regression analysis of the indicators at each hospital to quantitatively evaluate the change in practice following implementation of the dashboard and to identify factors most predictive of use. DISCUSSION: Study results will provide essential data to develop knowledge translation strategies for facilitating practice change, which can be further evaluated through a future cluster randomized trial.

Psychometric Testing of the French Language Quality of Prenatal Care Questionnaire.

BACKGROUND AND PURPOSE: To assess the psychometrics of the French language Quality of Prenatal Care Questionnaire (QPCQ). METHODS: Data from 302 women were used in a confirmatory factor analysis and in assessment of construct validity through hypothesis testing and internal consistency reliability using Cronbach's alpha. RESULTS: The 6 factors (subscales) were verified and confirmed. Hypothesis testing further supported construct validity. The overall QPCQ had acceptable internal consistency reliability (Cronbach's alpha = .97) as did 5 subscales (Cronbach's alpha = .70-.92); the Sufficient Time subscale had poorer reliability (Cronbach's alpha = .61). CONCLUSIONS: The French language QPCQ is a valid and reliable self-report measure of prenatal care quality. It can be used in research and in quality improvement work to strengthen prenatal care services.

Maternal intravenous fluids and postpartum breast changes: a pilot observational study.

BACKGROUND: The current breastfeeding initiation rate in Canada is approximately 87%. By one month, about 21% of women have stopped breastfeeding. Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. The aims of this pilot research study were to explore the relationship between intrapartum intravenous fluids given to mothers and postpartum breast swelling in the first 10 days postpartum and to determine if a larger study was warranted and feasible. METHODS: A prospective, longitudinal, observational cohort pilot study with repeated measures and a within-subjects design was completed. Participants were first time mothers who have a single, healthy newborn and had a spontaneous vaginal birth. Daily data collection from admission into the study until postpartum day 10 took place. Descriptive statistics are reported and linear regression analysis was used to model the relationship between IV therapy and postpartum breast edema. RESULTS: Women who received intravenous fluids during labour had higher levels of breast edema postpartum and rated their breasts as firmer and more tender than women who did not receive intravenous fluids. Participants who had intravenous fluids described patterns of fullness that appeared to be related to edema as opposed to fullness associated with engorgement and lactogenesis II. CONCLUSIONS: The findings demonstrate that mothers in this pilot study who received intravenous fluids in labour and postpartum had higher levels of breast edema. These results suggest a larger study is warranted to more fully examine the effects of intravenous fluids on postpartum breast swelling.

Young women's experiences of expected health behaviors during pregnancy: the importance of emotional support.

Young women often have access to fewer resources to make expected behavior changes during pregnancy. This qualitative study aimed to explore the experiences of young pregnant and parenting women regarding behavioral expectations and behavior change during pregnancy. Nine women (aged 15 to 24) participated in individual semistructured photo-elicitation interviews and data was analyzed using qualitative content analysis. The findings of this study suggest that although these young women received informational support throughout their pregnancies, there is a need to integrate emotional support into prenatal care for young pregnant women to facilitate their experience as one of empowerment rather than oppression.

Women's perspectives of the fetal fibronectin testing process: a qualitative descriptive study.

BACKGROUND: In 2009 the Ontario Ministry of Health and Long Term Care funded the implementation of province-wide fetal fibronectin testing in Ontario hospitals. This paper reports results from the provincial evaluation that sought to describe the experience of fetal fibronectin testing from the perspective of women with symptoms of preterm labour. METHODS: A descriptive qualitative design was used, employing semi-structured telephone and face-to-face interviews with women who had fetal fibronectin testing. RESULTS: Five hospitals participated in recruiting women for the study and 17 women were interviewed. Women described their experiences of fetal fibronectin testing as an emotional process that moves from expecting, to feeling, to hoping for reassurance; and then to re-defining what is required to feel reassured. Women described feeling anxious while waiting for fetal fibronectin results. When test results were negative, women described feeling a sense of relief that their symptoms would not likely lead to an imminent preterm birth. Women with positive results expressed feeling reassured by the care decisions and quick action taken by the health care team. CONCLUSION: Fetal fibronectin testing was acceptable and beneficial to these women with symptoms of preterm labour. Implications for practice and future research are suggested.

Hospital-based perinatal nurses identify the need to improve nursing care of adolescent mothers.

OBJECTIVE: To determine whether hospital-based perinatal nurses with expertise in adolescent mother-friendly care identify a need to improve inpatient nursing care of adolescent mothers and how well perinatal units support nurses' capacity to provide adolescent mother-friendly care. DESIGN/SETTING/PARTICIPANTS: A key informant survey of nurses from eight perinatal units at three hospitals (four separate sites) in a Canadian city. METHODS: Perinatal nurses expert in the care of adolescent mothers were identified by their managers and colleagues. These nurses and all perinatal clinical educators were invited to participate. Twenty-seven of 34 potential key informants completed the survey. RESULTS: Key informants rated their own skill in caring for adolescent mothers higher (median 8.0) than they rated the skill of other nurses (median 6.0) on their units. They attributed their expertise working with adolescent mothers to their clinical and life experiences and their ability to develop rapport with adolescents. A common reason for the assigned lower peer-group ratings was the judgmental manner in which some nurses care for adolescent mothers. Key informants also identified that hospital-based perinatal nurses lack adequate knowledge of community-based resources for adolescent mothers, educational programs related to adolescent mother-friendly care were insufficient, and policies to inform the nursing care of adolescent mothers were not available or known to them. CONCLUSION: A minority of perinatal nurses have expertise in adolescent mother-friendly care. There is a need for perinatal unit-level interventions to support the development of nurses' skills in caring for adolescent mothers and their knowledge of community-based resources. Peer mentoring and self-reflective practice are promising strategies.

A qualitative study of family involvement in decisions about life support in the intensive care unit.

We explored family involvement in decisions about life support interventions in the intensive care unit study using a critical incident technique to focus on specific case exemplars contributed by participants. A total of 6 family members and 9 health care professionals were interviewed. Participants described 2 options (life support or comfort care) and values associated with options: maintaining quality of life, surviving critical illness, minimizing pain and suffering, not being attached to machines, needing adjustment time, and judicious health care resource use. Barriers to involvement included not being offered alternative options; no specific trigger to initiate decision making; dominant influence of professionals' values; and families lacking understandable information. Family members are unlikely to engage in decision making unless professionals identify the decision and address other barriers to family involvement.

An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss.

BACKGROUND: Newborn weight measurements are used as a key indicator of breastfeeding adequacy. The purpose of this study was to explore non-feeding factors that might be related to newborn weight loss. The relationship between the intravenous fluids women receive during parturition (the act of giving birth, including time in labour or prior to a caesarean section) and their newborn's weight loss during the first 72 hours postpartum was the primary interest. METHODS: In this observational cohort study, we collected data about maternal oral and IV fluids during labour or before a caesarean section. Participants (n = 109) weighed their newborns every 12 hours for the first three days then daily to Day 14, and they weighed neonatal output (voids and stools) for three days. RESULTS: At 60 hours (nadir), mean newborn weight loss was 6.57% (SD 2.51; n = 96, range 1.83-13.06%). When groups, based on maternal fluids, were compared (≤1200 mls [n = 21] versus > 1200 [n = 53]), newborns lost 5.51% versus 6.93% (p = 0.03), respectively. For the first 24 hours, bivariate analyses show positive relationships between a) neonatal output and percentage of newborn weight lost (r(96) = 0.493, p < 0.001); and b) maternal IV fluids (final 2 hours) and neonatal output (r(42) = 0.383, p = 0.012). At 72 hours, there was a positive correlation between grams of weight lost and all maternal fluids (r(75) = 0.309, p = 0.007). CONCLUSIONS: Timing and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss. Neonates appear to experience diuresis and correct their fluid status in the first 24 hours. We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change. Because practices can differ between maternity settings, we further suggest that clinicians should collect and analyze data from dyads in their care to determine an optimal baseline measurement.